September 18, 2012 in Billing and Collections by support Team | Comments Off on Potential Impact of the 2013 ACA changes in Medicaid Reimbursements to Pediatric Practices
We hear that children are the most important aspect of our Healthcare system and that preventive care has the best return on our health care dollar. So, why are Pediatricians continuously receiving the lowest average pay when compared to other physician specialties? There are many reasons for the low reimbursements including the significant gap in payments between Medicaid and Medicare. Family Practice and Internists rely both on Medicare and Medicaid while Pediatricians, due to almost all their patients being
Patients without a primary Pediatrician seek some of their care at the Hospital ER. Besides breaking the Medical Home concept, treating at the hospital is far more expensive than in a Pediatric office. The formers of the Affordable Care Act made a choice to invest in primary care versus urgent care by changing the law so that Medicaid reimbursements = Medicare Reimbursements. This change should help providers increase their panel of Medicaid patients and should benefit the cost curve as well. Lastly, the patients should see increased access to a Pediatrician. States would see >$10B in new funds from Health and Human Services to pay for the expanded cost (this is an investment by the Federal Government). The goal of this investment is to reward the primary care physician for preventive care.
When will this take effect? Starting in 2013, the reimbursements for Medicaid are to increase to Medicare Levels.
What does this mean? There are a few states that Medicaid currently pays above Medicare (Alaska, Wyoming) according to some reach by Sandra Decker whom is an Economics at the CDC (see article in the Washington Post dated August 6, 2012 http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/08/06/study-one-third-of-doctors-wouldnt-take-new-medicaid-patients-last-year/ )
Overall, statehealthfacts.org by the Kaiser Family Foundation (http://www.statehealthfacts.org/comparetable.jsp?ind=196&cat=4 ) shows that Medicare to Medicaid Fee index is .66 for the United States. The lowest states are Road Island (.36), New York (.36), New Jersey (.41), District of Columbia (.47) and CA (.47).
Will the New Medicaid pay the same as commercial Insurance? Generally, the answer is no. The reason is that although Sick and Well visits should, in most states, see an increase in reimbursement being paid, there will continue to be a significant gap in payments for Vaccine Administration codes by Medicaid. Recommend read the press release below. If your practice currently does not accept Medicaid Patients due to the low reimbursements, now is the time to consider changing the policy for the practice.
June 1, 2012 in Billing and Collections by support Team | Comments Off on Using Lean Six Sigma to Optimize the Revenue Cycle in Pediatric Practices
I enjoyed meeting with clients and potential clients in their Pediatric office. Pediatricians have such a challenging and rewarding career to treat the children of our future. Children should not be treated medically as “small adults” and have special needs and treatments based on a variety of factors including family history, their environment, social economic status, etc. Similar to the special needs of treating children, Pediatric Practices have specific needs to optimize the operation from a revenue cycle perspective. Unfortunately, I have seen too many Pediatric Practices where the practice is operating at a level that reduces the effectiveness of the practice as well as reduces the revenue cycle for the practice. When I walk in these practices I see money flowing out the door without the partners/owners knowing (usually because they do not have time as well as the training to see these gaps as well as the complexity of the revenue cycle). In many of these practices the missing revenue is thousands of dollars a month! There are many tools to help practices optimize there effectiveness including LEAN Six Sigma.
Lean Six Sigma is a quality tool that gained much fame via manufacturing processes (e.g. Toyota – quality focus) before being leveraged in other areas such as business processes and systems. One of the principles of lean six Sigma is continuous improvement in the operation and processes. So how can Lean Six Sigma be leveraged related to Pediatric Practice Management? Some examples include:
• Using LEAN principles to improve the Pediatric Revenue Cycle each month by identifying billing processes on the front end and back end of the revenue cycle that slow down the payment stream to the practice. One objective measure is Accounts Receivable (AR) Days. The AR days are simply the amount of Revenue Outstanding to be collected for the practice divided by the average revenue collected per day. An optimal practice should be below 30 (which means about a month of Accounts Receivable is pending at any one time). We are able to move some practices into the low 20s.
• Holding a Kaizen event to evaluate the front end and back-end of the revenue cycle for your practice. By involving the appropriate individuals to this event, practices can identify ‘pain points’ of the revenue cycle and some potential solutions/ideas on how to improve this pain point.
• Request the physicians and providers in the practice to evaluate and determine the amount of time spent documenting in the EMR system as well as the quality of the clinical documentation. Usually, one physician leader from the practice should be the point for this effort. The time invested should be to identify the most common as well as least common clinical conditions in the office, the time for needed for the visit and charting the visit as well as the consistency of the clinical documentation.
These are a few examples of how a Pediatric Practice can apply LEAN six Sigma principles to improve the practice. For the practice to appropriately apply a recommended improvement, it is critical that the practice leverages a Pediatric Electronic Health Record and Practice Management system that can be customized for the practice (Make sure and speak with your E.M.R./practice management system vendor to discuss if/how the system can be modified/customized based on practice process flow changes). Using LEAN Six Sigma can help improve the operation, the revenue as well as improve patient and provider satisfaction.
April 13, 2012 in Blog by support Team | Comments Off on Continuity of Care in Pediatric Practices & the Link to Cloud-Based E.H.R. Systems
While at the pharmacy waiting for prescription Medication, I experienced the gap in knowledge by the average patient. One patient requested a medication to treat his wife’s pink eye from the pharmacist. When she explained that his wife will need an antibiotic he asked if he could use the antibiotic he was using to treat his ears. She explained to him that his wife needed a health care provider to exam her then based on the diagnosis, prescribe the appropriate medication for her red eyes. The husband was not coordinating care with his wife’s primary care physician.
Many in the health care system are missing the big picture when they do not call their primary care physician. In pediatrics, the outcome of the patient can be improved via strong continuity of care. If a patient is atopic and calls the office about a reaction to a medication, the pediatrician can use this information to appropriately manage the patient as well as record the incidence in the patient’s history. From the patient’s point of view, strong coordination with their pediatric office could reduce their burden and costs associated with using the Emergency Room. The pediatrician receives calls after office hours. The information available to the pediatrician should be able to be accessed easily at any time. Cloud-based Pediatric E.H.R. systems provide the best option for easy access to patient information on multiple devices in multiple locations…smart phones, IPads, lap tops, home computers. Who wants the burden of ‘dial in’ to the office server as well as maintaining constant security of the server?
As coordination of care continues to evolve as well as the option in wireless devices, Pediatricians can continue to reduce admin burden, costs and improve continuity of care with cloud-based E.H.R. Systems.